Smith-Modified Sgarbossa Criteria and Paced Rhythms: A Case Report.

BACKGROUND: As the incidence of left bundle branch blocks (LBBBs) and paced-rhythms electrocardiograms (ECGs) increase in the aging global population, the need for rapid and accurate diagnosis of ST-elevation myocardial infarction (STEMI) or STEMI equivalents in patients with these rhythms becomes more imperative. The Sgarbossa and Smith-modified Sgarbossa criteria have been documented to enhance the diagnosis of STEMI in the setting of LBBBs. However, there is a growing body of literature that suggests that these criteria can also be applied for the diagnosis of STEMI in patients with paced rhythms.

CASE REPORT: We present the case of an 84-year old man who was on admission for cellulitis when he developed acute respiratory distress. An ECG revealed findings that were consistent with positive Smith-modified Sgarbossa criteria, upon which the diagnosis of STEMI was made. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although the sensitivity and specificity of these criteria in paced rhythms is not well documented, if a patient meets these criteria in an appropriate clinical setting, cardiac catheterization laboratory activation by an emergency physician could be appropriate.